Thematic Poster Session Hall 2-29 - 12:50-14:40 TUESDAY,SEPTEMBER 27TH 2011

Technology (NTNU), Trondheim, Norway; 3HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Levanger, Norway

Background: Anxiety is common among people with obstructive lung diseases. However, reduced lung function in combination with anxiety in relation to the reporting of dyspnoea is not well studied. Objectives: To study the association between reduced lung function and dyspnoea, and how anxiety affects this association. Methods: We analysed data on 5627 women and 5066 men who participated in the Lung substudy of the Nord-Trøndelag Health Study in 1995-97. In a cross- sectional design we used logistic regression to calculate multivariably adjusted odds ratios (ORs) for dyspnoea associated with levels of FEV1% predicted and anxiety (measured by the Hospital Anxiety and Depression scale). Results: Among women with FEV1 ≥100% predicted, those who had anxiety had an OR (95% confidence interval) for reporting dyspnoea when walking of 2.00 (0.68-5.90) compared to those without anxiety. Using the same reference group (FEV1 ≥100% predicted and no anxiety), women with FEV1 80-99% predicted had an OR of 2.46 (1.26-4.83) without anxiety and 7.67 (3.66-16.08) with anxiety, whereas those with FEV1 50-79% predicted had an OR of 4.61 (2.49-8.52) with- out anxiety and 14.37 (6.50-31.78) with anxiety. The corresponding ORs among men without and with anxiety were 1.00 (reference) and 4.55 (0.87-23.70); 1.15 (0.46-2.88) and 5.00 (1.82-13.73); and 4.10 (1.49-11.29) and 14.03 (4.04-48.76), respectively. The ORs for reporting dyspnoea at rest and waking up by dyspnoea showed similar patterns in both women and men. Conclusions: Reduced lung function in combination with anxiety had a stronger association with dyspnoea than reduced lung function alone.

P4113 Functional health status and satisfaction with health in a population reporting a participation or activity limitation: Focus on COPD Donna Goodridge1, Joshua A. Lawson2, Darcy Marciniuk3, Donna C. Rennie2, Koroush Madani3. 1College of Nursing, 2Canadian Centre for Health and Safety in Agriculture, College of Medicine, 3College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada

Background: Symptoms associated with COPD can result in participation and activity limitations as well as reduced quality of life. 421. Respiratory epidemiology: quality of life, Objective: To examine the impact of COPD on functional health status (FHS) and satisfaction with health (SWH) in persons with a participation or activity limitation therapy and socioeconomics among a national sample of Canadians. Methods: This survey used data from the 2006 Participation and Activity Lim- itation Survey (PALS), a complex population survey of Canadians reporting a disability on the census. COPD was present if there was a self-report of COPD, P4111 emphysema, or bronchitis as the cause of disability. FHS was assessed using Late-breaking abstract: Postmenopausal hormone replacement therapy is the Health Utility Index (HUI-3) and categorized as high, moderate, or severe. associated with increased risk of hospitalization SWH was categorized as high, moderate, or low. Analyses were weighted to the Klaus Bønnelykk1, Ole Raaschou-Nielsen2, Hans Bisgaard1, Anne Tjønneland2, population and bootstrapping used to estimate variances. Kim Overvad3,4, Zorana J. Andersen2. 1Danish Pediatric Asthma Centre, Results: The sample represents 5,185,980 adults with participation or activity Copenhagen University Hospital, Gentofte, Democratic Peoples Republic of limitation. Subjects without missing data (55%) for the variables of interest were Korea; 2Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, included. COPD was reported as the reason for disability in 1.4% of the popu- Denmark; 3School of Public Health, Aarhus University, Aarhus, Denmark; lation. Among those reporting COPD, 44% reported moderate and 49% reported 4Centre for Cardiovascular Research, Aalborg Hospital, Aalborg University, low SWH. FHS was moderately impaired for 31% and severely impaired for 46%. Aalborg, Denmark After adjustment, COPD was significantly associated with a lower SWH (p<0.05), but not with FHS (p=0.12). Background: Postmenopausal hormone replacement therapy (HRT) has been Conclusions: While FHS was similar to the overall population with a disability, associated with asthma, but is not yet an established risk factor. persons with COPD had a markedly lower SWH, suggesting the need to focus on Aim: To investigate, for the first time, the association between HRT use and risk quality of life enhancement strategies. of severe asthma exacerbations requiring hospitalization in a prospective study. COPD was analyzed simultaneously to account for potential misclassification. Methods: Intake of HRT and potential confounders, including smoking status, P4114 occupational exposure, educational level, body mass index, and hysterectomy, were Lung function decline predicts disability in valued life activities, which in assessed in 1993-1997 in 23 138 postmenopausal women from the Danish Diet, turn predicts impaired quality of life in COPD Cancer and Health cohort. Incident (first-ever) asthma and COPD hospitalizations Paul D. Blanc 1, Jonathan Singer1, Theodore A. Omachi1, Gabriella Sanchez2, were registered prospectively in Danish Hospital Discharge Register between 1993 Carlos Iribarren2 , Miriam Cisternas3, Patricia P. Katz1. 1Medicine, University of and 2006. Association with HRT was analyzed with Cox’s regression analyses. California San Francisco, San Francisco, CA, United States; 2Kaiser Division of Results: We observed 446 (1.9%) incident asthma hospitalizations in 23 138 Research, Kaiser Permanente, Oakland, CA, United States; 3MGC Data Services, women over 9.9 years mean follow-up. 11 575 (50.0%) women ever used HRT. MGC Data Services, Carlsbad, CA, United States Ever using HRT was positively associated with asthma hospitalization (hazard ratio [95% confidence interval]: 1.37 [1.14-1.65]). The risk was highest with the longest Background: Interrelationships among lung function, disability, and health-related duration of HRT use (≥ 10 years: 1.51 [1.15-1.98], 3-10 years: 1.34 [1.05-1.72], < quality of life (HRQL) in COPD need clearer delineation. 3years: 1.29 [1.00-1.67], reference never users). Effect modification was detected Methods: We carried out baseline/follow-up interviews, spirometry, and 6 minute by smoking, indicating strongest effect in never smokers (1.84 [1.32-2.56]) and no walk tests (6MWT) for 646 participants in a COPD cohort (42% male; age 59±6; effect in current smokers (1.08 [0.79-1.45]). HRT was also associated with COPD median follow-up 2.1 years). Valued Life Activities (VLA) disability was scored hospitalization, with a smaller effect (1.19 [1.05-1.35]). with a validated instrument; VLA increased disability [VLA-ID]=0.5 standard Conclusion: HRT use may cause asthma onset or worsening with severe exacer- deviation increase in score baseline-follow-up (14.6% disability). We assessed bation. respiratory-specific HRQL with the Airways Questionnaire 20-Revised. Logistic regression (including age, sex, height) estimated risk by change in absolute values of FEV1 and 6MWT for VLA-ID; linear regression (including the same covariates, P4112 VLA-ID, and baseline HRQL) predicted follow-up HRQL. Lung function and anxiety in association with dyspnoea – The HUNT study Results: Mean decline in FEV1=-91 ml; mean decline in 6MWT=-37 M. VLA-ID 1 2 1 1 Linda Leivseth , Tom Ivar Lund Nilsen ,Xiao-MeiMai , Roar Johnsen , predicted worsened HRQL (p<0.001). Although FEV1 decline predicted VLA-ID 3 1 Arnulf Langhammer . Department of Public Health and General Practice, (p<0.001), neither change in FEV1 or 6MWT was associated with change in Norwegian University of Science and Technology (NTNU), Trondheim, Norway; HRQL. Including FEV1 and 6MWT in multivariate modeling, VLA-ID retained 2Department of Human Movement Science, Norwegian University of Science and its relationship with HRQL (1.3 point change; effect size=0.29; p<0.001).

752s Abstract printing supported by . Visit Chiesi at Stand D.30 Thematic Poster Session Hall 2-29 - 12:50-14:40 TUESDAY,SEPTEMBER 27TH 2011

Conclusion: VLA-ID, but not FEV1 or 6MWT decrements, predicted HRQL P4117 impairment. Although FEV1 decline was associated with VLA-ID, worsening The restrictive spirometric pattern is associated with impaired health-related respiratory status did not directly account for HRQL changes. quality of life Clinical Relevance: Interventions directly focused on attenuating disability are Stefano Guerra1, Anne-Elie Carsin1, Jan-Paul Zock1, Benedicte Leynaert2, likely to be critical in preserving HRQL, independent of respiratory function or Christer Janson3, Deborah Jarvis4,JosepM.Anto1. 1Centre for Research in exercise capacity. Environmental Epidemiology, CREAL, Barcelona, Spain; 2INSERM, U700, Support: NIH HL077618, FAMRI CoE2007. Faculté Paris Diderot, Paris VII, Paris, France; 3Department of Medical Sciences: Respiratory Medicine & Allergology, Uppsala University, Uppsala, Sweden; 4National Heart and Lung Institute, Imperial College, London, United Kingdom P4115 Recreational activity limitation in subjects with and without COPD in five Previous population-based studies have shown that a restrictive spirometric pattern Latin American cities: The PLATINO study is present in a significant proportion of the adult population and is associated M. Montes de Oca1,C.Talamo1,D.Moreno1, A. Menezes2, R. Perez-Padilla3, with an increased risk in morbidity and mortality. However, whether and to M. Lopez4,A.Muiño4,J.Jardim5,G.Valdivia6,J.Pertuze6,R.Halbert7. what extent this pattern is associated with impaired quality of life remains to 1Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela; be determined. In this study, we used data from 6005 participants from eleven 2Faculdade de Medicina, UFPEL, Pelotas, Brazil; 3Pulmonary, INER, Mexico European countries and the US who completed lung function tests and the Short City, Mexico; 4Facultad de Medicina, Universidad de la República, Montevideo, Form-36 (SF-36) questionnaire during the second ECRHS survey. We defined Uruguay; 5Medical School, UNIFESP, São Paulo, Brazil; 6Facultad de Medicina, the restrictive spirometric pattern as FVC < 80% predicted plus FEV1/FVC ≥ PUC, Santiago, Chile; 7School of Public Health, UCLA, Los Angeles, United 70% and the obstructive spirometric pattern as FEV1/FVC < 70%. Physical and States mental component summaries (PCS and MCS) for health-related quality of life were computed and scores transformed so that the mean was 50 and the SD 10. COPD is a progressive and debilitating disease. With worsening disease, patients Mean age of participants was 43 years (range 28 - 56 years) and 51% of them were will progressively become less physically active, will have reduced social contacts, females. Overall, 5254 subjects (87.5%) had a normal, 415 (6.9%) a restrictive and this will create a downward vicious circle. Although much attention has and 336 (5.6%) an obstructive spirometric pattern. The mean PCS was 50.4, 46.9 focused on physical activity limitation, recreational and social activities limitation and 47.6 for subjects with normal, restrictive and obstructive spirometric patterns, are also important to assess the burden of the disease. respectively (p < 0.001). The corresponding MCS mean scores were 50.0, 50.1 We examined the frequency of recreational activity limitation due to health and 49.7 (NS). After adjustment for sex, age, body mass index and smoking, the and lung problem in a population-based study. We used post- restrictive spirometric pattern was associated with a -2.7 PCS deficit (p < 0.001) FEV1/FVC<0.70 to define COPD. Information regarding recreation limitation and the obstructive pattern with a -2.2 deficit (p < 0.001), as compared with the was assessed by the questions: “In the last 12-months, could you not perform normal spirometric pattern. In conclusion, the restrictive spirometric pattern is recreational activities due to your health problems?” and “In the last 12-months, associated with significantly impaired health-related quality of life for how many days in total could you not perform recreational activities due to health or lung problems? Interviews were completed in 5,571 subjects and spirometry was performed in P4118 5,314 subjects. There were 759 COPD and 4,554 individuals without COPD. Dyspnoea in COPD patients recorded in a primary care database Among subjects with COPD 81 (10.7%) reported recreation limitation due to Hana Mullerova1,ChaoLu1, Maggie Tabberer2. 1Worldwide Epidemiology, health problem, compared with 404 (8.9%) of non-COPD subjects (p<0.09). The Quantitative Sciences, GlaxoSmithKline R&D, Uxbridge, United Kingdom; number of days with recreational activities limitation due to health problem was 2Global Health Outcomes, GlaxoSmithKline R&D, Uxbridge, United Kingdom increased in COPD in comparison with non-COPD (171.7±18.5 vs. 99.6±7.41 days; p<0.001). Similar findings were observed in the limitation due to lung Background: Dyspnoea is a primary clinical feature of COPD [1,2]. Information problem (45.4±12.3 vs. 11.3±2.63 days; p<0.01). on dyspnoea recording in electronic medical record databases has not yet been These results indicate that COPD is associated important limitation of recreational reported. activities. Understanding the impact of COPD on participation into these activities Methods: A cohort was identified in the UK General Practice Research Database is important for appreciating the overall burden of the disease. (GPRD) (01/01/2003 – 30/6/2010) with both a COPD medical diagnosis code and spirometry (FEV1/FVC <70%) and 12months history before and after cohort entry. OXMIS/Read codes were used to identify and define records of dyspnoea P4116 as probable or possible (less likely associated with COPD) from cohort entry until ECME: Epidemiologic study of the characteristics of women with COPD in censoring. Spain Results: A cohort of 9502 patients was identified: mean age 67 y. (SD 11), Sagrario Mayoralas1, Salvador Diaz Lobato2, Esther Anton3, Xavier Ribera4, 55% males, GOLD stage I: 12%, II: 50%, III: 29%, and IV: 7%. At least one Irune Unzueta3. 1Pneumology Service, Hospital Moncloa, Madrid, Spain; “probable” dyspnoea code was found in 76% of COPD patients; “possible” codes 2Pneumology Service, Hospital Ramón y Cajal, Madrid, Spain; 3Medical were identified in 2% of patients. Codes most frequently associated with dyspnoea Department, Pfizer, Madrid, Spain; 4Medical Department, Boehringer Ingelheim, were “shortness of breath” (16% of patients) and MRC Dyspnoea Scale grade; Barcelona, Spain 45% patients recorded as grade 2, 34% grade 3 and 5.5% grade 4 (frequencies based on the total cohort). Dyspnoea was more often reported by older patients and Background: Chronic obstructive pulmonary disease (COPD) clinical trial popu- those with more advanced disease (69% patients in GOLD stage I with “probable” lations are often predominantly male (∼75%), thus the female population is not dyspnoea vs. 81% in GOLD stages II or IV). so well characterized. Conclusions: Dyspnoea was reported in > 75% of COPD patients identified in the Aims and objectives: Determine a clinical and sociodemographic profile of women GPRD. The high frequency of dyspnoea across all GOLD stages highlights this with COPD in Spain. symptom as a significant burden and possible unmet need in COPD treatment. MRC Methods: Multicenter, cross-sectional, observational epidemiological study. 379 Dyspnoea grade is the predominant code used, linked to the Quality Outcomes pulmonologists from health centers in Spain recruited female patients aged Framework, an NHS system supporting management of selected diseases. ≥40 yrs, smoking history ≥10 pk-yrs, current COPD diagnosis and receiving References: treatment/follow-up during pulmonologist visits. Clinical and sociodemographic [1] Bestall JC, Paul EA, Garrod R et al. Thorax 1999;54:581–6. data were collected during study visit. Descriptive statistics were performed. [2] GOLD: Pocket Guide, December 2010. Results: 1732 women evaluated, of which: 80.8% pulmonologist diagnosis; 46.6% Funded by GSK. primary, 30.8% secondary education; 60.1% current-, 39.9% ex-smokers; 25.5% and 43.1% with history of depression or anxiety, respectively; 78.3%, 65.3%, 63.1% receiving long-acting , long-acting β2-agonist/corticoid, short-acting P4119 β2-agonists. Mean±SD values: age, 61.6±10.0 yrs; body mass index, 26.7±5.1 Symptoms experienced by COPD patients during exacerbations and their kg/m2; time since, and age at, diagnosis, 7.5±6.4 yrs and 54.1±9.8 yrs; pre- association with healthcare utilization – EXACO study and post-bronchodilator FEV1/FVC, 57.5±12.3% and 57.8±12.2%; O2 satura- Isabelle Tillie Leblond, Frédéric Masure, Bruno Housset, Nicolas Roche, tion, 93.8±3.3%; PYI, 35.7±19.9; SF-12 PCS and MCS scores, 37.6±10.5 and Thierry Perez, Isabelle Boucot, François Denis, Aida Myftiu, Juliette Ostinelli, 45.7±12.0; LCADL total, personal care, and household, physical, leisure activities, Isabelle Pithois-Merli, Céline Pribil, Stephane Schück. Pneunology, CHRU 27.2±10.9, 6.5±2.9, 11.8±5.9, 4.5±1.6, 4.4±1.8. Median no. exacerbations in Calmette, Lille, France Pneunology, Groupe Médical Saint Rémi, Reims, France prior year, 1.0 (P25/P75: 0.0/2.0) Pneunology, CHU, Créteil, France Pneunology, Hôtel-Dieu, Paris, France Conclusions: Most women in this cross-sectional study were at an age that they Pneunology, CHRU Calmette, Lille, France Scientific Department, could be actively working. The average FEV1 and exacerbation history suggest an GlaxoSmithKline, Marly Le Roi, France Medical Department, Boehringer impact of the disease on these patients’ daily lives. Ingelheim, Paris, France Medical Department, Nycomed, Paris, France Medical Funded by Boehringer Ingelheim/Pfizer. Department, AstraZeneca, Rueil Malmaison, France Medical Department, Pfizer, Paris, France Epidemiology Department, GlaxoSmithKline, Marly Le Roi, France Scientific, Kappa Santé, Paris, France

Background: Definitions of COPD exacerbations are symptom-based while sever- ity assessment often relies on the level of healthcare utilization.

753s Abstract printing supported by . Visit Chiesi at Stand D.30 Thematic Poster Session Hall 2-29 - 12:50-14:40 TUESDAY,SEPTEMBER 27TH 2011

Objectives: To assess symptoms associated with COPD exacerbations and their ing asthma were invited. MSA was defined from the questionnaire as reporting association with patients’ decision to seek healthcare. physician-diagnosed asthma and reporting use of asthma , attacks of Methods: Patients with GOLD stage ≥ II COPD participating in an observational shortness of breath and recurrent wheeze and at least one additional respiratory study, reported symptoms and healthcare use associated with exacerbations by symptom. Asthmatic subjects not having MSA are referred to as “other asthmatics”. telephone interviews. Results: 92% of MSA used asthma medication at the time of the clinical exam- Results: 835 patients reported 3 527 exacerbations. The most common symptom ination, compared with 61% among “other asthmatics”. 71% were on treatment was increased breathlessness. 82.2% of led to a medical consultation, visit to a with steroids and 47% used long-acting β2-agonists (either combined with ICS or hospital. Fever was the symptom most strongly associated with the decision to separately) vs. 40% and 23%, respectively, for “other asthmatics”. Oral steroids seek healthcare. were used by 14% and by nebuliser by 6%, 18% used one or both of these. Frequency of symptoms reported during worsenings of respiratory state and association with Conclusion: Subjects with MSA are to a large extent treated with steroids. We seeking health care conclude that a large majority of multi-symptom asthmatics defined by using Symptom OR (95% CI) for a questionnaire have a more severe disease and only a minority does not use present seeking health care* maintenance treatment. N% Onset of sputum production 1500 42,5 1.2 (0.9–1.6) P4122 Increased sputum production 1159 32,9 0.8 (0.6–1.1) Correlates of high levels of use of short-acting beta agonists in asthma Sputum newly purulent (or more purulent than usual) 1343 38,1 2.0 (1.5–2.6) Laurent Laforest1, Jennifer Martin1, Idlir Licaj1, Gilles Devouassoux2, Onset of head cold 1408 39,9 1.1 (0.9–1.5) Gérard Chatte3, Mélanie Broquet1,EricVanGanse1. 1Unité de Increased breathlessness 2835 80,4 – Pharmacoépidémiologie, Université Claude-Bernard Lyon1, CHU Onset of cough 1547 43,9 1.6 (1.2–2.1) Lyon-Université Claude-Bernard Lyon1, Lyon, France; 2Respiratory Medicine, Increased cough 937 26,6 1.9 (1.4–2.6) Lyon Sud University Hospital, Pierre Benite, France; 3Respiratory Physician, Onset of fever 791 22,4 3.4 (2.2–5.0) Respiratory Physician, Caluire, France Onset of chest pain 810 23,0 1.1 (0.8–1.6) Onset of wheezing 1538 43,6 1.6 (1.2–2.1) Background: High use of short-acting beta agonists (SABAs) may reflect potential Borg score (increase of 1 point) – – 1.2 (1.2–1.3) risks in asthma management. A better understanding of the characteristics of high *Adjusted on age, sex, education level, COPD GOLD stage, chronic bronchitis profile, season of users of SABAs is critical to improve quality of care. exacerbation, and presence of cardiovascular comorbidities. Objectives: To describe asthma patients with high levels of use of SABA, including their characteristics and medical resource utilisation. Conclusions: Breathlessness was by far the dominant symptom of exacerbations Methods: A random sample of patients aged 16-40, with regular use of dis- while fever was the strongest predictor of health care utilization. pensed respiratory drugs (R03, ATC classification) in 2005 was selected from the French claims database (EGB). Asthma-related hospital admissions were retrieved. Patterns of use of SABAs in 2007 were described. The correlates (baseline char- P4120 acteristics and asthma-related variables) of using ≥ 12 SABA units in 2007 were Medication and preventive measures for COPD in the BOLD study identified. Louisa Gnatiuc1, Bernet Kato1, Sonia Coton1, Sonia Buist2, Peter Burney1. Results: Among 2093 patients (median age = 33 year-old, 54% females), 65% 1Respiratory Epidemiology and Public Health, Imperial College London, were using SABAs in 2007 and 8% used ≥ 12 units during this period. These London, United Kingdom; 2Pulmonary & Critical Care Medicine, Oregon Health patients were more likely to have a long-term disease status (p<0.001), free-access- & Science University, Portland, United States to-care status (p<0.01), to use higher levels of systemic corticosteroids (p<0.001), and antibiotics (p<0.001) than other patients. Higher numbers of medical visits Background: Inhaled beclomethasone and are three to five times as (p<0.001) and asthma-related hospital admissions (p<0.01) were also observed expensive in poorest settings resulting in poor access (Ait-Khaled N, Rev Mal in this group. Conversely, no noticeable difference appeared with age, nor with Respir 2006, 23, 10S76-10S79). We used the BOLD data to describe differences gender. in reported medication use for COPD. Conclusions: Many patients are still using high levels of SABAs and are possibly Methods: Preventive measures for COPD (flu vaccine in last year, advice or at risk of exacerbations. The reasons of this high use of rescue medication require medication ever to stop smoking) and use of respiratory in the last a better understanding. year among population-based samples of adults aged 40+ with spirometrically defined COPD, were assessed across 18 BOLD sites. Results: Over 14,300 subjects had information on flu vaccine and medication use. P4123 Over 7,900 had information on smoking cessation. Prevention strategies and med- Ratio “inhaled corticosteroids to total anti-asthma drugs”, and ication use were significantly more common in the High Income Countries (HIC) asthma-related hospital admissions and in people with COPD than in Low and Middle Income Countries (LMIC) and Laurent Laforest1, Jennifer Martin1, Idlir Licaj1, Gilles Devouassoux2, those with normal spirometry (p<0.000). Differences across countries were not Gerard Chatte3,EricVanGanse1. 1Unité de Pharmacoépidémiologie, 11 rue related to COPD prevalence. Guillaume Paradin, Lyon University Hospital, Claude-Bernard Lyon1 University, Bronchodilators and inhaled corticosteroids use increased with age, severity of Lyon, France; 2Respiratory Medicine, Lyon Sud University Hospital, Lyon, COPD, BMI, any comorbidity or respiratory symptom and it was higher among France; 3Respiratory Physician, Respiratory Physician, Caluire, France the unemployed (p<0.000). After stratifying by country economic level, the use of these medicines was independent of education level and higher among the Background: The inadequate use of inhaled corticosteroids (ICS) remains an unemployed in HICs (p<0.000). The use of medication was not related to pack- issue in asthma. The ratio of ICS units to total anti-asthma medications dispensed years of smoking. However, after stratifying by gender the use bronchodilators and (ICS/R03 ratio) may be useful to assess the risk of severe exacerbations, leading inhaled corticosteroids was significantly higher in women smoking 20+ pack-years to asthma-related hospitalisations (ARHs). We tested this hypothesis using claims (p=0.04). data. Conclusion: The use of COPD prevention and medication is significantly higher Objectives: To verify in claims databases whether patients with a higher ICS/R03 in HICs than in LMICs. Improving access to care in LMICs is important, as is ratio experience fewer ARHs. understanding risk factors for low medication uptake. Methods: A random sample of patients aged 16-40, with regular use of respiratory drugs in 2005 was selected from the French national claims database (EGB). Three groups were defined according to the value of ICS/R03 ratio in 2007: 0% (“non P4121 users”), <50% (“non users”) and ≥50% (“non users”). ARHs in 2007 and 2008 Medication use in multi-symptom asthma: Results from the West Sweden were compared between the 3 groups. asthma study Results: Among 1812 patients (mean age=32 year-old, 54.2% females), non users, Linda Ekerljung, Jan Lötvall, Bo Lundbäck. Department of Internal inadequate users and adequate users, were 17%, 37% and 46%, respectively. ARH Medicine/Krefting Research Centre, University of Gothenburg, Gothenburg, rate was 0.9% in 2007 (0.7% in 2008). Patients with ARH in 2007 were more Sweden numerous (p=0.0006) among inadequate users (2.10%), compared with adequate

users (0.24%) and non users (0.32%). Differences were also observed in mean

Background: Multi-symptom asthma (MSA) can be defined in epidemiological ARH-induced costs: 2.16 , 48.30 and 3.70 for non users, inadequate, and studies and has been shown to reflect severity. It has been uncertain if the definition adequate users (p=0.0005). Conclusions were similar for ARHs in 2008. Over reflects a more severe disease or is a result of inadequate use of asthma medication. 80% of adequate users in 2007 remained in this group in 2008. The prevalence of MSA in West Sweden is 2.0%, representing 24% of subjects Conclusions: Patients with ICS/R03 ratio ≥50% experience fewer ARHs than with physician-diagnosed asthma. The current study aims to determine the use of inadequate users, suggesting improved asthma control. ICS/R03 ratio may help asthma medication in a group with MSA. identify asthma patients at risk of ARHs in administrative databases. Methods: From a randomly selected population of 18 087 subjects aged 16-75, who participated in a postal survey on respiratory symptoms, a random sample of 2000 was selected for clinical examinations and interview, including questions on use of asthma medication. In addition all remaining subjects (n=1536) report-

754s Abstract printing supported by . Visit Chiesi at Stand D.30 Thematic Poster Session Hall 2-29 - 12:50-14:40 TUESDAY,SEPTEMBER 27TH 2011

P4124 exacerbation type. The model simulates COPD incidence, prevalence, (severe) The pattern of use of asthma medication in adolescents and young adults: exacerbations, disease progression (annual decline in FEV1% predicted) and A nationwide study on 2.2 million people mortality. Main outcome variables are quality-adjusted life years (QALYs) and Lars Pedersen1, Emil Fosbøl2, Gunnar Gislason2, Fredrik Folke2, COPD-related healthcare costs. The exacerbation-related input parameters were Casper Lund-Andersen2, Christian Torp-Pedersen2, Backer Vibeke1. based on quantitative meta-analysis. All important model parameters are entered 1Respiratory and Allergy Research Unit, Department of Respiratory Medicine, into the model as probability distributions. To illustrate potential use of the model, Bispebjerg Hospital, Copenhagen NV, Denmark; 2Department of Cardiology, 10-year costs and effects were projected for three different COPD interventions, one Gentofte University Hospital, Copenhagen, Denmark pharmacological (ICS+LABA), one on smoking cessation and one on pulmonary rehabilitation.

Pharmacological treatment of asthma is highly effective in controlling symptoms Results: Compared to minimal intervention, the 10-year cost/QALY ratio of 3-year and improving quality of life. Within the last 15 years new drugs such as combi- implementation was 8,300 for ICS+LABA, 10,800 for the smoking cessation

nations of ICS and long-acting beta-2-agonists (LABA) and modifiers therapy and 17,200 for pulmonary rehabilitation. If the maximum willingness to

for treating asthma has been introduced on the Danish market. Studies have shown pay would be 20,000/QALY, the probability that the cost/QALY was lower than that these drugs have changed the pattern of prescription, but most studies on that varied from 58% for pulmonary rehabilitation to 100% for ICS+LABA. prescription pattern of asthma medication have studied selected populations or Conclusions: The COPD model provides policy makers with comparable in- population samples. formation on long-term costs and effects of interventions ranging from primary The study aimed to identify patterns of use of asthma medication in adolescents prevention to care for very severe COPD and includes uncertainty around the and young adults in an unselected population. outcomes. The study population comprised all Danish individuals aged 10-40 years at January 1 1996 (2,213,264 individuals). The population was followed until the end of 2006. From the national Danish prescription registry we collected data on all asthma P4127 medication (ATC code R03) claimed by the study population. Fragmented care in asthma: Data from the French national claims database At every year in the study period, beta-2-agonists were the most commonly claimed Laurent Laforest1, Jennifer Martin1, Idlir Licaj1, Gilles Devouassoux2, drug both in number of users and number of prescriptions. The first years of the Gerard Chatte3, Melanie Broquet1,EricVanGanse1. 1Unité de study, there was an increasing use of LABA, but after the introduction of combined Pharmacoépidémiologie, 11 rue Guillaume Paradin, Lyon University Hospital, ICS and LABA, the use of LABA decreased whereas there was a steady increase Claude-Bernard Lyon1 University, Lyon, France; 2Respiratory Medicine, in use of ICS and LABA in fixed combinations. When leukotriene modifiers were Lyon-Sud University Hospital, Lyon, France; 3Respiratory Physician, Respiratory introduced in 1998, usage increased rapidly the first two years and then plateaued Physician, Caluire, France with only a small yearly increase. The use of theophyllines more than halved during the study. Background: Asthma management is a major public health issue. Little is known This study on the use of asthma medication in an unselected population shows a about the frequency of fragmented care in asthma patients. It is also unclear shift in the use of asthma medication, but short-acting beta-2-agonists remained whether those patients induce higher levels of medical resource utilisation (MRU). the most frequently used drug. Objectives: To determine the proportion of asthma patients being prescribed asthma therapy by ≥ 2 different general practitioners (GPs), and the medical resource utilisation (MRU) induced by these patients. P4125 Methods: A random sample of patients aged 16-40, with at least 3 reimbursements Inhaler use among asthmatics – A cross sectional study in Alappuzha and of respiratory drugs (R03, ATC classification) was identified in the French national Kottayam districts of Kerala, India claims database (EGB). Among them, those with at least 2 visits with prescriptions P. Sulaiman Shajahan. Pulmonary Medicine, Medical College, Kottayam, Kerala, for respiratory drugs in 2007 were selected. Fragmented medical care in 2007 was India defined as receiving prescription for respiratory drugs from ≥ 2 different GPs. Patients’ MRU was studied according to the number of distinct GPs prescribing Introduction: Asthma is an important health problem worldwide.Medcations in respiratory drugs in 2007. the inhaled forms are the best therapeutic options currently available for asthma [1]. Results: Among 1,009 patients (mean age = 32 year-old, 59% females), nearly Despite this, the percentage of patients opting inhalers as the preferred modality 55% of patients received their respiratory therapy from ≥ 2 different GPs (2: 36%, of treatment seems to be low [2]. 3: 13% >3: 6%). A salient increase in the dispensing of short-acting beta agonists Aims: 1. To find out the proportion of asthmatics using inhalers as the preferred in 2007 was observed with the level of fragmented care in 2007 (p<0.001). Like- modality of treatment. 2. To bring out the various reasons for not using inhalers wise, fragmented care was associated with free-access-to-care status (p<0.01), among the above study group. more asthma-related admissions (p<0.01) and medical visits in 2007 (p<0.001). Materials and methods: Study subjects were asthmatics in the age group of 15 to Conversely, no major association was observed as to patients’ age and gender. 45 years who attended the medical camps conducted in Alappuzha and Kottayam Conclusions: Our data suggest that fragmented asthma care is not exceptional and districts of Kerala, India during the period 2006 - 2009 (n= 912). A semi structured may result in higher unscheduled MRU. The reasons of fragmented care require a interview schedule on the use of inhalers were administered to collect the data. better understanding to optimise the quality of care in asthma. Results: 52% of the study subjects accept inhaled preparations as the preferred modality of treatment (male-64%, female-39%). 48% are reluctant to take inhalers (male-32%, female-65%). 47% believe the term inhaler is the name of a particular P4128 drug rather than a device (male-45%, female-48%). 76% of inhaler users do not Productivity loss in ever-smoking COPD subjects from a general population know how to use it properly. 7% of inhaler users think the powder in the dry Rune Nielsen1, Ane Johannessen2,3, Per Sigvald Bakke1,3,Ernst powder inhalers can block the airways. Reidar Omenaas2,3, Amund Gulsvik1,3. 1Department of Thoracic Medicine, Recommendations: More health awareness programmes are needed to alleviate Haukeland University Hospital, Bergen, Norway; 2Centre for Clinical Research, fears and misconceptions about inhaled medications. Patients should be properly Haukeland University Hospital, Bergen, Norway; 3Institute of Medicine, trained on correct usage of inhalers. University of Bergen, Bergen, Norway References: [1] National Asthma Education and Prevention Program. (EPR-3):J Allergy Clin Background: We aimed to estimate productivity losses of chronic obstructive Immunol. 2007 Nov;120(5 Suppl):S94-138. pulmonary disease (COPD) in hospital- and population-based subjects with spiro- [2] Riccioni G, et al. Clin Ter. 2007 Jul-Aug;158(4):363-70. metric post-bronchodilator COPD, relative to a control group. Methods: 53 COPD-cases and 107 randomly recruited individuals without COPD were included from a general population. 102 COPD patients were recruited P4126 from a hospital register. All participants were ever-smokers, 40-66 yrs of age. Comparing the cost-effectiveness of a wide range of COPD interventions In 4 standardized telephone interviews we surveyed the utilization of sick leave using a stochastic population model for COPD and disability pension during one calendar year. Productivity loss was defined as Martine Hoogendoorn1, Maureen Rutten-van Mölken1, Rudolf Hoogenveen2, number of days in sick leave or disability pension. The outcomes in a two-part Maiwenn Al1, Talitha Feenstra3,4. 1Institute for Medical Technology Assessment regression approach were any productivity loss (multiple logistic regression) and (iMTA), Erasmus University, Rotterdam, Netherlands; 2Expertise Centre for number of days of lost productivity (multiple linear regression). The latter model Methodology and Information Service, National Institute for Public Health and excluded subjects without any productivity loss. the Environment (RIVM), Bilthoven, Netherlands; 3Department for Prevention Results: The logistic regression model showed little effect of COPD when we and Health Services Research, National Institute for Public Health and the compared the population-based COPD cases to the controls. In the linear regression Environment (RIVM), Bilthoven, Netherlands; 4Department of Epidemiology, model the increased productivity loss in population-based subjects with stage II, University Medical Centre Groningen, Groningen, Netherlands stage III and stage IV COPD were (95% CI) 73 (22 - 124), 178 (49 - 308) and 249 (33 - 465) days, compared to the controls. In addition, being a woman, a 1-yr Objectives: To develop a stochastic population model of disease progression in increase in age and low education was associated with an increase of 59 (15 - COPD that includes the impact of COPD exacerbations on health-related quality 103), 6 (2 - 10) and 131 (65 - 197) days of productivity loss. Similar results were of life, costs, disease progression and mortality and allows assessment of a wide found for hospital recruited COPD patients. range of different interventions. Conclusion: The access to sick leave and disability pension was similar in subjects Methods: The model is a multistate Markov model with time varying transi- with and without COPD. The volume of these services was considerably higher in tion rates depending on age, sex, smoking status, COPD disease severity, and/or subjects with COPD and was also associated with disease severity.

755s Abstract printing supported by . Visit Chiesi at Stand D.30 Thematic Poster Session Hall 2-29 - 12:50-14:40 TUESDAY,SEPTEMBER 27TH 2011

P4129 Socioeconomic correlates of hospitalization, medical visits and utilization of diagnostic tests in asthmatic children in Poland Jan E. Zejda, Grzegorz M. Brozek, Irena Smolka. Department of Epidemiology, Medical University of Silesia, Katowice, Poland

A recent (2010) population-based questionnaire survey of 4535 children aged 5-15 years in Katowice District, Poland yielded 186 cases (3.9%) of physician- diagnosed asthma. In the last 12 months 5.9% of asthmatic children underwent respiratory hospitalization and 44.0% were seen by physician, 30.6% had spirom- etry, and 24.7% skin prick tests, and all of those outcomes strongly depended on asthma attacks in the last 12 months. The goal of the study was to find out if other than health-related factors could also explain the examined outcomes. In univariate analyses hospitalization was related to age (p=0.007), medical visits to age (p=0.009), spirometry to rural residence (p=0.007), skin prick tests to age (p=0.001) and number of siblings (p=0.01). The identified correlates were tested by a multivariate regression - the table shows logistic Odds Ratios (and 95% CIs) if p=<0.1:

Explanatory Variable Hospitalization Medical Visit Spirometry Skin Prick Test Attacks od asthma 4.5 (1.2–18.4) 14.0 (6.3–31.3) 2.0 (1.0–4.0) 1.9 (0.9–4.0) Age <10 years 6.2 (1.2–30.5) 2.1 (1.0–4.3) p=0.9 3.1 (1.5–6.5) Number of siblings <2 p=0.4 p=0.5 1.7 (0.8–3.6) 3.2 (1.3–7.6) Rural residence p=0.8 1.94 (0.7–4,9) 4.9 (1.6–15.0) 2.5 (0.9–7.4)

Clinical status of asthmatic children and their young age are important determi- nants of utilization of medical care and diagnostic procedures. The effect of rural residence and family size may reflect a better maternal care over a sick child and/or better compliance with medical advice – in both settings (rural and urban) diagnostic tests require time consuming arrangements with specialized centers, usually located at a distance from family physicians’ surgeries.

756s Abstract printing supported by . Visit Chiesi at Stand D.30